Tuesday, January 10, 2012

That scary term - managed care

We all can remember when the concept of managed care came out. It was done by insurance companies and designed to benefit us. Yeah right. It meant we couldn't see the doctors we wanted because of they are out of network or the care we needed was denied. Well, now there is a new concept in health care which has two key differences from managed care.

The name. Its now called Accountable Care.

Its now focused on improving patient care. The managed care version was designed to "benefit everyone but patients".

So we have a fancy new name that is supposed to improve patient care. Why do we think us cynical Americans have no faith or trust in their health insurance companies? Because possibly we don't trust them? You mean the people who approve a procedure and then decide to 'unapprove' it once you have it done and you are stuck with a giant bill? Once burned twice shy, as the saying goes.
So what is Accountable Care anyway? Its called team work. Accountable care includes doctors, nurse care managers, pharmacists, health coaches, and more. Its a new concept being piloted by Medicare in certain parts of the country, including Eastern Massachusetts.

"Primary care doctors and some specialists increasingly are leaning on
other staff members to help care for such patients. Staff pharmacists
explain patients’ medication schedule and watch for negative drug
interactions, health coaches teach people about their diseases or help
them to lose weight, and nurse care managers take on a wide variety of
tasks, including making sure a patient gets necessary lab work and
follow-up care.

“Patients will feel that there’s more contact, that there are people who
know them better, who are looking after them and providing them with
more feedback,’’ Gilfillan said."

Traditionally doctors are paid for face to face appointments with their patients. Under Accountable Care,they will be compensated and rated on: "the care that their patients get throughout the health care system.
That’s meant to encourage more coordination between hospitals and with
other providers, so that physicians, for example, become more involved
in the care their patients receive at rehabilitation facilities."

As a professional patient, I am all for looking at the big picture. Now I think medical facilities and doctors are concerned with the care that the patients receive under their care and less on the overall big picture. They don't care because there is no compensation for other care or for focus on the big picture. Patients are responsible for juggling appointments and getting test results from one place to another. We can't see our doctors or anyone with the flexibility we need to get the emotional support that our health is really being cared for.

When did the 'care' leave 'health care'? Maybe under 'accountable care', there will be 'care' again. But its still a pilot program so we will need to be patient patients while we wait for the 'care' to return.

1 comment:

Accountable care start with first yourself. If you are willing to know or are curious for breast awareness then all system start working for you. So never stop yourself by lying that you know how healthy you are????

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About Me

Married to the most wonderful man.
My list of ailments so you can keep up: slowly healing left sprained ankle, right knee partially torn ACL, left knee osteoarthritis, bursitis both hips, lymphedema issues left arm, tennis elbow right arm, degenerating disks in my back - a chronic issue that cannot be repaired by surgery and only the symptoms can be treated and some weird neuro muscular issues that causes all kinds of pain in my upper back. Oh, and then there is that cancer thing twice now... But I'm still here.

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If you want to follow my story and ramblings through the medical world, you need to start reading the oldest post first which is at the very bottom or you can jump to it by going to June 2007 and look for 'My Big Announcement'. I started this blog so I could keep my friends and family up on my dealings with breast cancer but now it has evolved into my take on the medical world as well as my medical ups and downs. I have not listed my email address but if you know me, you know how to contact me. I always welcome emails. You can also find me on Twitter @carolinemfr and on Facebook. Otherwise, feel free to leave a comment!

But no I do not write about suggested topics or other people's blogs or other ailments so do not bother asking. Sorry.